In an African female infant with exstrophy who was a candidate for complete reconstruction of the urinary tract, pelvis, and abdominal wall, the treatment program was simplified by performing iliac osteotomies at the same time as the other repairs, using a single transverse lumbosacral incision for access. A series of 3 wire loops held the symphysis in apposition. A plaster spica, followed by a plaster girdle, minimized the tension on the pubic wires. We believe that we obtained, by this method, superior strength and a better appearance of the abdominal wall and perineum.